MEDICARE: BILLY JOHNSTON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	OTR1322	AR

General Provider Information

NPI Number	:	1083634224
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BILLY JOHNSTON

Provider Business Mailing Address
First Line	:	19 BRENTWOOD CV
Second Line	:
City	:	CABOT
State	:	AR
Zip	:	72023-7301
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1214 HWY 49 NORTH
Second Line	:
City	:	BRINKLEY
State	:	AR
Zip	:	72012-2122
Country	:	US
Telephone Number	:	501-804-2304
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/20/2006
Last Update Date	:	07/08/2007

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Directions to “ BILLY JOHNSTON ” Practice Location

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